CPT 15116Surgery

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CPT 15116 covers epidermal autografting (skin grafting using the patient's own skin cells) for areas of the face, scalp, eyelids, mouth, neck, ears, hands, feet, and/or genitalia, for each additional 100 square centimeters or part thereof, or each additional 1% of body area of infants and children.

Showing rates for

National Average

Base Medicare rate

$149.44

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

2.5

PE RVU (NF)

1.56

MP RVU

0.56

Total RVU

4.62

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Accurately measure and document total surface area grafted in square centimeters or body surface area percentage. Use burn charts and photographic documentation to support measurements.
Impact: Each correctly billed unit of 15116 generates $149.44 (non-facility); undermeasurement of a 400 sq cm graft area by documenting only 200 sq cm results in loss of $298.88
Always bill 15116 with primary code 15115 (first 100 sq cm). Code 15116 cannot be billed independently as it is an add-on code with a ZZZ global period.
Impact: Billing 15116 alone results in automatic denial; proper sequencing ensures payment of both base code ($298.88 for 15115) and each additional unit
Document donor site location, size, harvest technique (e.g., CelluTome, Zimmer dermatome), and recipient site preparation in operative note to support medical necessity.
Impact: Comprehensive documentation reduces audit risk and appeals; missing donor site documentation is the leading cause of post-payment audits reducing recovery rate to 40%
For pediatric patients, document whether measurement is by square centimeters or percentage of body surface area (BSA). BSA percentage is often more appropriate for infants and small children.
Impact: Proper BSA documentation for pediatric cases prevents undercoding; a 5% BSA graft in an infant equals ~500 sq cm, justifying 5 units of 15116 totaling $747.20
Verify that the anatomical location qualifies for 15115/15116 (face, scalp, eyelids, mouth, neck, ears, hands, feet, genitalia). For trunk/arms/legs use 15135/15136 instead.
Impact: Using incorrect code family results in denial or downcoding; 15115/15116 reimburses approximately $40-60 more per unit than 15135/15136 due to higher complexity

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Frequently asked questions

What is the difference between CPT codes 15115 and 15116?

CPT 15115 is the primary code covering the first 100 square centimeters (or first 1% of body area for infants/children) of epidermal autograft on face, scalp, eyelids, mouth, neck, ears, hands, feet, or genitalia. CPT 15116 is an add-on code used for each additional 100 sq cm or each additional 1% beyond the first area. For example, a 250 sq cm graft would be coded as 15115 (first 100 sq cm) plus two units of 15116 (for the additional 150 sq cm). 15116 cannot be billed without 15115.

How much does Medicare pay for CPT code 15116 in 2025?

Medicare pays $149.44 for CPT 15116 in non-facility settings (physician office) and $133.59 in facility settings (hospital) based on the 2025 national average rates. Actual reimbursement varies by geographic location due to locality adjustments. The code has a work RVU of 2.5, PE RVU of 1.56 (non-facility) or 1.07 (facility), and MP RVU of 0.56, totaling 4.62 RVUs with a conversion factor of 32.3465.

How do you calculate the number of units for CPT 15116?

Calculate total surface area grafted in square centimeters, subtract the first 100 sq cm (covered by 15115), then divide the remainder by 100, rounding up any partial amount. For example: 350 sq cm total = 15115 (first 100 sq cm) + 3 units of 15116 (remaining 250 sq cm ÷ 100 = 2.5, rounded to 3). For pediatric patients using body surface area percentage, subtract the first 1% (15115), then bill one unit of 15116 for each additional 1% or part thereof.

Can CPT 15116 be billed with debridement codes?

Yes, but with caution. Debridement codes (11042-11047) can be billed with 15116 if the debridement is extensive and beyond the normal wound bed preparation included in the graft procedure. Documentation must clearly distinguish between wound bed preparation (included in graft codes) and separate, extensive debridement. Modifier 59 may be required to indicate a distinct procedural service. Many payers bundle debridement with grafting, so ensure documentation supports medical necessity and separate procedure status to avoid denials.

What documentation is required to bill CPT 15116?

Required documentation includes: exact surface area measurements in square centimeters or body surface area percentage; specific anatomical locations of graft sites; donor site location and harvest technique; wound bed preparation performed; medical necessity for autograft selection; graft application and fixation method; body diagrams or burn charts showing graft placement; and photographic documentation when available. The operative note must clearly support the number of units billed with explicit measurements, not estimates.

What anatomical areas qualify for CPT 15116 versus other graft codes?

CPT 15116 (with 15115) is specifically for epidermal autografts on face, scalp, eyelids, mouth, neck, ears, orbits, hands, feet, and/or genitalia. These are considered high-complexity areas due to cosmetic and functional importance. For epidermal autografts on trunk, arms, or legs, use CPT 15135/15136 instead. For dermal or split-thickness grafts, use different code families (15271-15278 for dermal, 15100-15101 for split-thickness trunk/arms/legs, 15120-15121 for split-thickness face/scalp/hands/feet/genitalia). Using the wrong code family will result in denial or downcoding.

Is CPT 15116 covered by insurance for cosmetic procedures?

CPT 15116 is typically covered when medically necessary for treatment of burns, traumatic injuries, chronic wounds, or reconstructive purposes following disease or surgery. Purely cosmetic applications are generally not covered by Medicare or most commercial insurers. Medical necessity must be clearly documented with wound etiology, failed conservative treatments, and clinical justification. Cosmetic scar revision or elective aesthetic procedures using epidermal grafts would be patient-pay. Obtain prior authorization when medical necessity might be questioned to avoid denial and patient balance billing issues.